Nursing care in the chronic phase of COPD: a call for innovative disciplinary research

Abstract

The literature on nursing care in nurse clinics that focus on chronic management of chronic obstructive pulmonary disease (COPD) is analysed and synthesised with the purpose of advancing research of practice in nurse clinics. Along with the rising prevalence of COPD and a growing recognition of long-lasting, comprehensive and complex healthcare needs of people with COPD and their families, nurses are challenged to restructure their practice. An integrated review was conducted. The databases searched were NCBI's PubMed database, Scopus, CINAHL and Web of Science from 1996 to 2006. Terms searched were 'COPD' and 'nurse managed clinic' with all subheadings. A nurse had to be primary in managing and providing the services and the methodological approach was inclusive. Of 385 potentially relevant papers, 20 papers reporting 16 studies met the inclusion criteria. The methodological approach was diverse with randomised controlled trials being most common. Significant benefits from experimental treatments were seldom demonstrated. Nursing care in the chronic phase of COPD has mainly been conceptualised as: home-based respiratory care; self-management educational programmes and telephone service with influences of specialisation in respiratory nursing care on patients' outcomes as an emphasis as well. Family focus was not found in any of the studies. Research on nurse clinics that focus on the chronic phase of COPD is in its infancy. Innovative research that addresses the structure and content of the nursing care is essential. Nursing care in nurse clinics that focus on the chronic phase of COPD needs to be based on nursing knowledge, evidence based, comprehensive, family-centred, focused on health and the health experience and be situated within the service system. Diversity, creativity and nursing values should prevail when developing nurse clinics for the purpose of creating possibilities to attend to the whole of patients' and their families' needs and experiences.